Identifying Origin of Nonpulmonary Vein Triggers Using 2 Stationary Linear Decapolar Catheters: A Novel Algorithm

Area of Science:

• Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• Targeting nonpulmonary vein triggers (NPVTs) of atrial fibrillation (AF) post-pulmonary vein isolation presents challenges.
• NPVTs often manifest as single ectopic beats with P-waves obscured by QRS or T-waves.

Purpose of the Study:

• To develop an algorithm for regionalizing the origin of NPVTs using intracardiac electrograms.
• The algorithm utilizes data from catheters in the right atrium and coronary sinus.

Main Methods:

• An algorithm was constructed using electrogram activation sequences and timing from two linear decapolar catheters.
• Pacing from 15 known NPVT sites was performed in 42 AF patients post-pulmonary vein isolation.
• The algorithm's predictive value was assessed in a validation cohort using electroanatomic mapping.

Main Results:

• The algorithm achieved high precision in grouping 15 pacing sites into 9 clinically relevant regions (PPV 81%-99%, Specificity 94%-100%, Sensitivity 30%-94%).
• Validation in 98 patients demonstrated a predictive accuracy of 91% for localizing AF NPVTs.
• The algorithm effectively regionalized NPVT origins, aiding in focused mapping strategies.

Conclusions:

• An algorithm based on electrogram sequence and timing from two multipolar catheters accurately regionalizes AF NPVTs.
• This approach facilitates focused mapping, improving the management of complex atrial fibrillation cases.